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The Centers for Disease Control and Prevention (CDC) have provided new data suggesting that it is becoming common to not only diagnosis attention deficit hyperactivity disorder (ADHD) in 2- and 3-year-olds – but also to prescribe medication to these toddlers. As reported in the New York Times, data collected by the CDC suggested an estimate that 10,000 young toddlers are being given stimulant medication. And, of course, it could be more and the number could be growing.

There are many problems with diagnosing and medicating young toddlers for ADHD. Here are three primary issues:

ADHD is difficult to diagnosis – even in older children. While comprehensive, multidisciplinary clinical teams can offer productive diagnostic assessments of school aged children, ADHD is still difficult to diagnosis with certainty. It’s clear from prior analyses and studies that many school aged children are being given diagnoses of ADHD without such careful clinical evaluation and put on medications that they may not need. Given this, the idea that ADHD can be reliably diagnosed in 2- and 3-year-olds is shaky, to say the least – or simply not advisable.

The effects of stimulant medications in young toddlers have not been studied. Stimulant medications require careful clinical monitoring in school-aged children. It is controversial to administer them to 4- and 5-year olds. Prescribing them to 2- and 3-year-olds is not within the clinical boundaries. There is a reason that drugs are studied and approved for specific conditions and age groups. We don’t know the side effects of stimulants on young toddlers or how they influence the developing brain.

Behavioral management of toddlers is important but can be achieved without medication. Young toddlers need to be socialized. They need to have some structure and learn boundaries. They need to know how to modify their behavior in different settings. These are developmental goals, not the stuff of psychiatric diagnosis. If parents are having difficulties with young toddlers – and as we know, they can be rambunctious, as they should be – it’s certainly worth thinking about getting some advice or even learning behavioral management techniques that can be especially effective with some youngsters. The idea that this process may be circumvented by inappropriate clinical diagnosis and drug treatment is very troubling – especially since there is good evidence that behavioral techniques work and no evidence supporting the use of stimulant medication in young toddlers.

At the recent Mom 2.0 Summit, I heard from a lot of moms who described recent debates – at their children’s schools – about the role of the arts in early education. In particular, during a series of roundtable workshops and discussions led by Elmer’s Products, Inc, numerous stories were shared about schools that are reducing – or cutting completely – time for the arts (particularly the visual arts and crafting ) in order to focus exclusively on “academics” (meaning reading and mathematics). As a developmental researcher, this practice is disconcerting to me, as it reflects a fundamentally flawed perspective on cognitive development in the early, formative years of life.

We’ve known for decades the value of hands-on activities in early childhood. Arts and crafts, as typically practiced in preschool and the early formal school years, have always been recognized as a primary way of promoting the all-important fine motor skills that provide a primary mechanism for cognitive exploration and learning (hence the value of literal “hands-on learning”). Current research has begun to uncover even more benefits. Thus, a central component of these many conversations at Mom 2.0 focused on an emerging paradoxical situation in education: as the research evidence supporting involvement in the arts increases, the opportunities for young children to engage in the arts may be declining.

The argument for “academics rather than arts” is simple – the primary goal of education is to accelerate the development of formal scholastic skills like reading, writing, and mathematics. Of course, children’s cognitive capacities extend far beyond these core “academic” abilities. Initiatives like STEAM (science, technology, engineering, arts, mathematics) provide compelling frameworks that integrate the arts with science and mathematics. Developmental researchers have begun to articulate how the arts, in the early years, support the development of core cognitive skills (skills that are applicable to a wide range of academic subjects). For example, research conducted in partnership with Elmer’s Let’s Bond initiative identified, via survey of experts in child development, three such processes fostered by participation in arts and crafts:

Educational research Jennifer S. Groff has provided a compelling theoretical model and rationale for the primary role that the visual arts play in development and education in an influential paper published in the Harvard Educational Review. Consider this summation from the abstract of that paper:

Emerging research on the brain’s cognitive processing systems had led Groff to put forth a new theory of mind, whole-mindedness. Here she presents the evidence and construct for this frame of mind, how it sits in relation to multiple intelligences theory, and how it might redefine the justification for arts education in schools, particularly in our digitally and visually rich world.

The point about our “digitally and visually rich world” deserves a bit of expansion. Groff argues that visual information processing – those core brain processes engaged by the visual arts – are a primary cognitive skill set and primary mechanism for how children learn. As our world becomes more visually driven, we are beginning to understand in greater depth just how important these abilities are for learning and cognitive development. Promoting these critical abilities via the arts do not come at the sacrifice of developing traditional “academic” skills. Rather, the arts not only offer support for later verbal and mathematical fluency, but also provide essential platforms for enhancing and fostering core cognitive skills that are essential for today’s young children.

The emerging story of school stabbings at a high school in Murrysville, PA, will inevitably stir up debates about school violence, mental health, and gun control. For example:

The point will be made that it’s not all about guns at school. This is true – knives and other weapons can be used to cause harm. We need to understand how a range of weapons can be used by individuals who intend harm at schools.

The point will be made that we need to learn more about the factors that cause individuals to attempt mass murder. This is true. We need targeted research that will have, as an endpoint, strategies for identifying youth who may be on the verge of such behavior and routing them to interventions.

The point will be made that schools need to be better protected. This is true. Many schools have increased their security procedures and will need to continue to revisit them as necessary, and prioritize these initiatives.

What shouldn’t happen, however, is a myopic focus on just one issue and dismissal of the other issues – the kind of polarization that stymies progress. We can’t focus on just guns/knives/etc without thinking about mental health issues. We can’t just put all of our resources into the mental health angle without considering how we reduce access to weaponry in youth. School security is an ongoing concern because it is impossible to completely secure a school every second of the day, and as such we have to continue to refine how risk is minimized. There are of course other issues that should be examined and put into the mix. Serious public health concerns like school violence require at a minimum a multifactorial perspective and ideally a synergistic evaluation of many of the root issues.

A month long journey in a sailboat sounds like an exciting time for a kid. An adventure. And maybe a needed dose of risk taking in this age of perceived overprotection. But what about if that kid is 3 years old? How about 1 year old? Is this too risky?

It’s easy to say that it is when the baby gets sick, the boat gets stranded, and a massive rescue effort is necessary. The resulting storm over parenting seems to be landing on that conclusion.

What’s especially interesting is that this story may help illuminate what we mean by “safe risk taking.” I recently described an example of safe risk taking - the Noodle Forest exhibit at the Children’s Museum of Phoenix (which is composed of densely packed, suspended pool noodles). The “risk taking” part was described as follows:

For a toddler, it can be a little disorienting making your way through the Noodle Forest. You do indeed get immersed in the noodles – you can’t see or hear much of anything else. You have to push your way through it and the noodles swing back at you. I’ve tried it myself and it is surprising how quickly you feel like you are, well, working your way through a Noodle Forest.

Of course, there is little physical danger, and a parent/guardian is nearby. The point of Noodle Forest is that it gives toddlers a chance to get out of a psychological comfort zone in a safe way. This is important, as kids’ play opportunities are not only getting limited in terms of opportunities, but also being compromised by safety concerns which can make playgrounds feel unchallenging. The point is to give kids chances to push themselves, not just physically, but psychologically, to try new things, things that might even seem a little scary, without putting them into situations that carry too much potential for harm.

The bigger point, though, is that kids develop a sense of efficacy when they are the ones who control the experience. Being put in a situation that carries risk and potentially compromises heath and well-being isn’t safe risk taking – it’s simply risk. We as parents need to keep that in mind when we determine, for ourselves, our algorithm that computes what’s a “safe risk” for a kid and what’s being placed at risk.

How early can you see extraordinary sports ability? Well, consider that, in Europe, toddlers are being signed to professional contracts as footballers (soccer players). For example, last fall a 20-month-old was scooped up after his father had posted a YouTube video showing his ball handling and kicking skills.

While sports signings have gotten younger and younger over the years, this story is intriguing to say the last because, well, it’s really hard to tell what toddlers are going to be like when they grow up. We could dig up examples of many athletes who showed promise at an early age, or advanced abilities. You can watch a clip of a toddler named Tiger Woods hitting a golf ball on national television when he was not yet three years old. And of course, the discussion doesn’t have to be limited to sports – similar stories could be found about musical prodigies.

We will have to wait more than a decade to find out how these toddlers fare as professional athletes. They may in fact turn out to become professionals and maybe even excel. But before we see a surge of YouTube videos of kids demonstrating their sports skills, let’s keep a few things in mind.

First, it’s really hard to figure out who’s going to be great even when athletes are turning professional at the normative ages. Think about the extraordinary time, effort and expertise that goes into drafting professional football players. Think about the careful decision making that results in a player being selected as a first round draft pick. The assumption would be that they all become stars. In fact, over the last decade or so, only about 30% of all the first round draft picks have been selected as Pro Bowl players.

Check out the list of Heisman Trophy winners (“the most prestigious award in college football”) and see how many have become stars. Think about who’s not on that list, players like Tom Brady. Consider his career trajectory. He was a backup quarterback for his first 2 years in college, and was drafted in the 6th round with the 199th pick. Yes, 198 players were drafted before the player who is frequently called the best football player ever. Have a look at the 6 quarterbacks drafted before Brady and see how their careers compare to his.

The point is that it’s hard for decision makers to look into that crystal ball even when athletes are of age and have gone through all the requisite training before turning professional. There are certainly objective benchmarks that are measured as they do in the NFL scouting combine. Interviewing is done to assess character and motivation. There is no shortage of performance data and video. Yet it’s still a probabilistic process at best.

All of this is offered because many of us want to put our children in a position to excel at earlier and earlier ages. There’s nothing inherently wrong with that. But the problem becomes when the stakes get raised when kids should just be growing up and learning to love the things that they are doing. Excessive pressure to achieve is not to be confused with support and encouragement to do their best. There’s no need to document this pressure. You can see it at any age. Certainly not all parents, not even the majority of parents. But that feeling is palpable. Kids aren’t just playing a game. They are performing with a lot riding on it, well before an age where that should be a relevant concern. And that fact is kids are most likely to succeed when they invest their time in something that they like and learn to love.

Some “prodigies” do in fact go on to experience great success as professionals. Many don’t. We often hear about the “numerator” in that fraction – the number who achieve that level of success. We don’t typically hear as much about the “denominator” – those individuals plus all those who don’t reach that ultimate level of greatness.

So when you hear about prodigies, or see other kids who look like they are going to be stars, don’t up the pressure on your kid. Make sure they are getting the most out of their experiences – their successes and their failures. Encourage their effort and enthusiasm and determination and their growth. Let them find their passions over time, even if it takes some time. And in that process they will define their own success.

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About The Author

Richard Rende, PhD, is an associate professor of psychiatry and human behavior at Brown Medical School and Butler Hospital. He received a BA in Psychology from Yale University, an MA in Psychology from Wesleyan University, a Ph.D. in Human Development and Family Studies from Penn State University, and postdoctoral training in Clinical and Genetic Epidemiology at Columbia University. Read Full Bio